Treatment-seeking practices of caregivers for children aged less than five years old with diarrhoea in low- and middle-income countries: a systematic review and meta-analysis.

Background: Diarrhoeal diseases in children aged <5 years require immediate medical attention. However, previous studies conducted on treatment-seeking practices of caregivers for children aged <5 years with diarrhoea in low- and middle-income countries (LMICs) were inconsistent and inconclusive. We aimed to estimate the pooled treatment-seeking practice of caregivers for children aged <5 years with diarrhoea in LMICs.

Methods: We used the 2020 PRISMA guidelines to conduct this systematic review and meta-analysis. We included both published and unpublished articles in English that reported treatment-seeking practices from health facilities in LMICs between 2010-22. We searched CINAHL, Medline/PubMed, Web of Science, Embase, and grey literature sources. We assessed the eligible articles using the Newcastle-Ottawa Scale quality appraisal checklist and Begg's test for the presence of publication bias. Further, we used the regression-based Egger test to test for a small study effect. Moreover, we used a narrative synthesis to characterise the studies. We estimated the pooled treatment-seeking practice using a random-effect model. We conducted a subgroup analysis considering the articles' publication status, residence, World Bank income category, study design and approach, and study setting. We presented the results using tables, figures, forest plots, and funnel plots.

Results: We included 76 articles in the analysis. The overall treatment-seeking practices of caregivers were 52.84% (95% confidence interval (CI) = 47.51-58.17). Healthcare-seeking practices in low-income countries (58.12%), lower-middle-income countries (48.41%), and upper-middle-income countries (51.44%) were not statistically different. The pooled treatment-seeking practice for diarrhoea varied by study site: 29.80% (95% CI = 25.00-34.60) in peri-urban, 54.20% (95% CI = 44.71-63.70) in rural, and 47.76% (95% CI = 34.47-61.06) in urban settings. A cross-sectional design was employed in 72 studies, and 71 were quantitative.

Conclusions: Treatment-seeking practice for diarrhoea among children aged <5 years in LMICs remained low. There was no statistically significant difference in treatment-seeking practice for children with diarrhoea by the country's income classification. We recommend further studies to identify factors affecting treatment-seeking practices for diarrhoea among children aged <5 years in LMICs and to act on findings and recommendations.

Registration: PROSPERO: CRD42022290180.